Treatment patterns, healthcare resource utilization, and costs in Medicare patients with diffuse large B-cell lymphoma: a retrospective claims analysis (2015-2020).

AIMS: To understand treatment patterns, healthcare resource utilization (HCRU), and the economic burden of diffuse large B-cell lymphoma (DLBCL) in elderly adults in the US. MATERIALS AND METHODS: This retrospective database analysis utilized US Centers for Medicare and Medicaid Services Medicare fee-for-service administrative claims data from 2015 to 2020 to describe DLBCL patient characteristics, treatment patterns, HCRU, and costs among patients aged ≥66 years. Patients were indexed at DLBCL diagnosis and required to have continuous enrollment from 12 months pre-index until 3 months post-index. HCRU and costs (USD 2022) are reported as per-patient per-month (PPPM) estimates. RESULTS: A total of 11,893 patients received ≥1-line (L) therapy; 1,633 and 391 received ≥2 L and ≥3 L therapies, respectively. Median (Q1, Q3) age at 1 L, 2 L, and 3 L initiation, respectively, was 76 (71, 81), 77 (72, 82), and 77 (72, 82) years. The most common therapy was R-CHOP (70.9%) for 1 L and bendamustine ± rituximab for 2 L (18.7%) and 3 L (17.4%). CAR T was used by 14.8% of patients in 3 L. Overall, 39.6% (1 L), 42.1% (2 L), and 47.8% (3 L) of patients had all-cause hospitalizations. All-cause mean (median [Q1-Q3]) costs PPPM during each line were $22,060 ($20,121 [$16,676-$24,597]) in 1 L, $30,027 ($20,868 [$13,416-$31,016]) in 2 L, and $47,064 ($25,689 [$15,555-$44,149]) in 3 L, with increasing costs driven primarily by inpatient expenses. Total all-cause 3 L mean (median [Q1-Q3]) costs PPPM for patients with and without CAR T were $153,847 ($100,768 [$26,534-$253,630]) and $28,466 ($23,696 [$15,466-$39,107]), respectively. CONCLUSIONS: No clear standard of care exists in 3 L therapy for older adults with relapsed/refractory DLBCL. The economic burden of DLBCL intensifies with each progressing line of therapy, thus underscoring the need for additional therapeutic options.

Economic burden and health-related quality of life in patients with epidermolysis bullosa in Spain.

BACKGROUND: . Epidermolysis bullosa (EB) is a rare genetic skin disorder characterized by fragility of skin with appearance of acute and chronic wounds. The aim of this study was to determine the economic burden and the health-related quality of life (HRQoL) of patients with epidermolysis bullosa (EB) in Spain from a societal perspective. METHODS: . We conducted a cross-sectional, retrospective study including 62 patients with EB (62% dystrophic, 9.6% junctional, 3.2% Kindler syndrome, and 26% with simplex EB). Data were collected from questionnaires completed by patients or their caregivers. The costs were estimated, including not only direct healthcare costs but also direct non-healthcare costs and productivity losses. We compared severe EB (Dystrophic, Junctional EB and Kindler syndrome) to non-severe EB (simplex EB) using as reference year 2022. HRQoL was measured by generic (EQ-5D) and specific (QoLEB) questionnaires. RESULTS: The average annual cost for an EB patient was €31,352. Direct healthcare costs represented 17.2% of the total cost, direct non-healthcare costs (mainly informal care costs) 71.3% and productivity losses 11.5% of the total cost. Participants in the severe EB group had a slightly higher average cost than participants in the non-severe EB group (€31,706 vs. €30,337). Direct healthcare costs and non-healthcare costs were higher in the severe EB group (€6,205 vs. €3,024 and €23,148 vs. €20,113) while productivity losses were higher in the non-severe EB group (€7,200 vs. €2,353). The mean utility index score, where the maximum value possible is one, was 0.45 for patients with severe EB (0.76 for their caregivers) and 0.62 for those with non-severe EB (0.77 for their caregivers). CONCLUSIONS: . The social economic burden of EB, resulting from the high direct non-healthcare cost of informal care, and from the loss of productivity, accentuates the importance of not restricting cost analysis to direct healthcare costs. This substantiates that EB, particularly severe EB represents a significant hidden cost that should be revealed to society and should be considered in the support programmes for people who suffer from this disease, and in the economic evaluation of new treatments.

The cost-of-illness of multiple sclerosis in Jordan.

BACKGROUND: Multiple Sclerosis (MS) imposes a significant financial burden on health-care systems. This study aims to determine the cost-of-illness (COI) for MS in Jordan, a country where data on the economic impact of MS are scarce. METHODS: Data were collected for one year, annual COI was estimated using a cross-sectional snowball sampling design. Eligible patients completed a self-reported questionnaire to provide sociodemographic, physician visit, and diagnostic and laboratory test data. Indirect costs were estimated using an adjusted Human Capital Approach. RESULTS: This study included 383 patients, (73% females, 61% between 26-45). Eighty % took disease-modifying therapies (DMTs), and 40% had relapses in that year. One-third use non-DMTs and equipment for assistance. The average annual cost per patient was $11,719 (direct costs=$11,252, indirect costs=$467). The total annual cost for all participants was $748,299. The estimated cost of non-DMT, medical tools, diagnostic tests, and hospitalization per patient was $53, 51, 99, and 235 respectively. CONCLUSION: High costs of DMTs state the necessity of resource optimization in Jordan public healthcare facilities. Such findings yield policy-informing actionable insights, suggesting strategic investments in more cost-effective DMTs with potential improvement in accessibility and reduction in the overall economic burden faced by both patients and governments.

Estimating the societal cost of heroin dependence in an Australian population engaged in treatment or harm reduction services.

INTRODUCTION: Heroin dependence is a public health concern in Australia. High mortality rates, increased risk of physical/mental health comorbidities and increased risk of social issues contribute to a high personal and societal cost. The aim of this paper is to understand the societal cost of heroin dependence in an Australian population. METHODS: A longitudinal cohort study of 600 people with heroin dependence were interviewed at five timepoints. Resource use was determined from interviews and was multiplied by unit costs to estimate the annual healthcare, productivity, crime and other costs (homelessness, heroin drug and prison costs). The monetary value of premature mortality was calculated using the value of a statistical life year method. RESULTS: The annual mean societal cost of heroin dependence in Australia was A$120,599/person. This included healthcare costs (A$10,055), lost productivity costs (A$63,158), crime costs (A$7204) and other costs (A$40,182). Healthcare costs, lost productivity costs, crime costs and other costs trended downwards over the five waves. Lost productivity was the highest cost contributor (52 %), followed by heroin drug (25 %). The estimated number of life years lost due to heroin over the 11-year study period was 2703 years, which approximates to a monetary value of premature death of $213 million. DISCUSSION AND CONCLUSIONS: The significant societal cost emphasises the importance of providing resources to heroin dependence. The cost of lost productivity, crime and heroin contributed to over 80 % of the total costs, which highlights the illicit nature and reduced capacity to work contributes to the high costs to society.

Epidemiological profile trends and cost of pediatric sickle cell disease in Brazil from 2008 to 2022.

OBJECTIVE: This study aimed to investigate the epidemiological trends of Pediatric Sickle Cell Disease (SCD) in Brazil over the period 2008-2022, with a focus on understanding the incidence, mortality rates, and associated healthcare costs. The study explored potential associations between patient characteristics and the occurrence of crises in pediatric SCD cases. METHODS: A cross-sectional study was conducted, analyzing national annual rates of pediatric SCD hospitalizations using data from the FioCruz platform. Descriptive and inferential analyses, including time series and ARIMA regression, were employed. Economic dimensions were assessed using cost categorization. The study followed STROBE reporting guidelines. RESULTS: Data on 81,942 pediatric SCD hospitalizations were collected, with a predominance of crisis-related cases (74.08 %). Males and children under five years old were most affected. Regional disparities were observed, with the Southwest region recording the highest hospitalization rates. ICU costs were higher for crisis-related hospitalizations. Mortality rates were significantly higher for crisis-related cases (p < 0.001), with ARIMA regression indicating a significant association between hospitalizations for crisis-related cases and mortality. CONCLUSION: This study highlights the significant burden of pediatric SCD in Brazil, particularly crisis-related cases, suggesting a need for focused interventions. By prioritizing early detection, equitable access to healthcare, and evidence-based interventions, Brazil can mitigate the burden of SCD and improve patient outcomes. These findings contribute to informing public health policies and interventions aimed at addressing the challenges of pediatric SCD management in Brazil.

Systematic Review of the Cost of Illness of Parkinson's Disease from a Societal Perspective.

Previous reviews on the cost of illness (COI) of Parkinson's disease (PD) have often focused on health-care costs due to PD, underestimating its effects on other sectors. This systematic review determines the COI of PD from a societal perspective. The protocol was registered in PROSPERO (ID: CRD42023428937). Embase, Medline, and EconLit were searched up to October 12, 2023, for studies determining the COI of PD from a societal perspective. From 2812 abstracts, 17 studies were included. The COI of PD averaged €20,911.37 per patient per year, increasing to almost €100,000 in the most severely affected patients. Health-care costs accounted for 46.1% of total costs, followed by productivity loss (37.4%) and costs to patient and family (16.4%). The COI of PD strongly varied between different geographical regions, with costs in North America 3.6 times higher compared to Asia. This study is the first to identify the relative importance of different cost items. Most important were reduced employment, government benefits, informal care, medication, nursing homes, and hospital admission. There was strong variety in the cost items that were included, with 55.2% of cost items measured in fewer than half of articles. Our review shows that PD-COI is high and appears in various cost sectors, with strong variety in the cost items included in different studies. Therefore, a guideline for the measurement of COI in PD should be developed to harmonize this. This article provides a first step toward the development of such a tool by identifying which cost items are most relevant. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

The economic cost of direct smoking in South Korea.

Background: Smoking not only causes negative health outcomes for individuals but also causes an economic burden to society. This study estimated the socioeconomic costs of direct smoking in South Korea in 2020. Methods: We used the prevalence-based cost-of-illness approach to estimate the sum of the direct (medical, transportation, and caregiving) and indirect (productivity loss due to health service utilization and premature death) costs of 41 smoking-related diseases. We assumed that diseases with death-based hazard ratios greater than 1.0 were related to smoking and used them in cost estimation. Results: The socioeconomic cost of direct smoking in Korea was USD 10.9 billion in 2020, accounting for 0.67 % of the gross domestic product and 8.0 % of current health expenditures. The direct cost was USD 4,172 million and the indirect cost was USD 6,753 million. The cost of productivity loss due to premature death took up the largest amount of the total cost, accounting for 52.3 %. The amount attributed to males accounted for 90.4 % of the overall cost, totaling to USD 9,877 million. This is attributable to higher smoking rates and higher medical costs in men. Cancer costs accounted for 40.0 % of the total cost, causing the greatest burden of diseases. Conclusion: Direct smoking imposed a harmful and heavy economic burden on South Korea. Our estimate provides the latest evidence on the financial burden of smoking and strengthens the case for strong tobacco control policies and interventions.

Modeling the Clinical and Economic Burden of Therapeutic Inertia in People with Type 2 Diabetes in Saudi Arabia.

INTRODUCTION: Therapeutic inertia in type 2 diabetes, defined as a failure to intensify treatment despite poor glycemic control, can arise due to a variety of factors, despite evidence linking improved glycemic control with reductions in diabetes-related complications. The present study aimed to evaluate the health and economic burden of therapeutic inertia in people with type 2 diabetes in Saudi Arabia. METHODS: The IQVIA Core Diabetes Model (v.9.0) was used to evaluate outcomes. Baseline cohort characteristics were sourced from Saudi-specific data, with baseline glycated hemoglobin (HbA1c) tested at 8.0%, 9.0%, and 10.0%. Modeled subjects were brought to an HbA1c target of 7.0% immediately or after delays of 1-5 years across time horizons of 3-50 years. Outcomes were discounted annually at 3.0%. Costs were accounted from a societal perspective and expressed in 2023 Saudi Arabian Riyals (SAR). RESULTS: Immediate glycemic control was associated with improved or equal life expectancy and quality-adjusted life expectancy and cost savings in all scenarios compared with delays in achieving target HbA1c. Combined cost savings ranged from SAR 411 (EUR 102) per person with a baseline HbA1c of 8.0% versus a 1-year delay over a 3-year time horizon, to SAR 21,422 (EUR 5291) per person with a baseline HbA1c of 10.0% versus a 5-year delay over a 50-year time horizon. Discounted life expectancy and quality-adjusted life expectancy were projected to improve by up to 0.4 years and 0.5 quality-adjusted life years (QALYs), respectively, with immediate glycemic control. CONCLUSION: Therapeutic inertia was associated with a substantial health and economic burden in Saudi Arabia. Interventions and initiatives that can help to reduce therapeutic inertia are likely to improve health outcomes and reduce healthcare expenditure.

Economic burden of patients with leading cancers in China: a cost-of-illness study.

BACKGROUND: China accounts for 24% of newly diagnosed cancer cases and 30% of cancer-related deaths worldwide. Comprehensive analyses of the economic burden on patients across different cancer treatment phases, based on empirical data, are lacking. This study aims to estimate the financial burden borne by patients and analyze the cost compositions of the leading cancers with the highest number of new cases in China. METHODS: This cross-sectional cost-of-illness study analyzed patients diagnosed with lung, breast, colorectal, esophageal, liver, or gastric cancer, identified through electronic health records (EHRs) from 84 hospitals across 17 provinces in China. Patients completed any one of the initial treatment phase, follow-up phase, and relapse/metastasis phase were recruited by trained attending physicians through a stratified sampling procedure to ensure enough cases for each cancer progression stage and cancer treatment phase. Direct and indirect costs by treatment phase were collected from the EHRs and self-reported surveys. We estimated per case cost for each type of cancer, and employed subgroup analyses and multiple linear regression models to explore cost drivers. RESULTS: We recruited a total of 13,745 cancer patients across three treatment phases. The relapse/metastasis phase incurred the highest per case costs, varying from $8,890 to $14,572, while the follow-up phase was the least costly, ranging from $1,840 to $4,431. Being in the relapse/metastasis phase and having an advanced clinical stage of cancer at diagnosis were associated with significantly higher cost, while patients with low socioeconomic status borne lower costs. CONCLUSIONS: There were substantial financial burden on patients with six leading cancers in China. Health policymakers should emphasize comprehensive healthcare coverage for marginalized populations such as the uninsured, less educated, and those living in underdeveloped regions.

The societal cost of 'unwanted' loneliness in Spain.

Unwanted loneliness negatively affects people's health and quality of life, increasing morbidity and the risk of premature death; this situation can generate major social costs. The aim of this study is to estimate the social costs of loneliness in Spain for 2021: both tangible costs -monetary value of health costs and production losses- and intangible costs -Quality Adjusted Life Years (QALYs). To estimate costs not derived from mortality, information from a sample of 400 people with unwanted loneliness was compared with that derived from two samples of the general population obtained from the Spanish National Health Surveys. To estimate the costs associated with premature deaths, the population attributable fraction was calculated using the relative risks estimated in previous survival studies. In the baseline scenario, the tangible costs of unwanted loneliness are estimated to be around 14,129 million euros in 2021, representing 1.2% of Spain's GDP. Approximately 56.8% of the tangible costs correspond to production losses due to reduced working time, and 43.2% are due to healthcare costs related with increased consultation frequency in healthcare services and higher consumption of medicines related to loneliness. In addition, loneliness generates a reduction in quality of life equivalent to 1.04 million QALYs, which corresponds to 2.8% of the total stock of QALYs of the Spanish population over 15 years of age.

Demographic Data, Risk Factors, and Disease Burden of HS Patients in Lithuania at a Reference Center.

BACKGROUND: Hidradenitis suppurativa (HS) diagnosis often faces a global delay of 7.2 years due to factors like lack of recognition, stigma, and socioeconomic barriers. Limited effective therapies and frequent exacerbations impact patients' quality of life, posing a significant burden on healthcare systems. METHODS: HS patients were assessed according to European Hidradenitis Suppurativa Foundation (EHSF) Registry questionnaire guidelines at various stages of the disease and treatment. RESULTS: The study included 49 patients; 57.14% (n = 28) of them were male. The average age of the subjects was 39.91 ± 13.665 years; the average BMI was 27.84 ± 7.362. A total of 59.18% (n = 29) were active or previous smokers. There were statistically more male smokers than female (p < 0.01). Average disease onset was 25.71 ± 13.743 years; the mean time to diagnosis was 5.2 ± 7.607 years. A total of 70.2% (n = 33) were previously misdiagnosed. Subjects had 6.17 ± 6.98 painful days over the preceding 4 weeks. The average intensity of pain according to the visual analogue scale (VAS) was 5.60 ± 3.36 points. The mean dermatology life quality index (DLQI) at baseline was 8.9 ± 7.436. CONCLUSIONS: The research revealed delayed diagnoses, especially for females. Smoking was linked to higher Hurley stages, with a prevalence among male smokers, and HS had a substantial impact on patients' quality of life.

Impact of cancer on the mortality of patients with idiopathic inflammatory myopathies by flexible parametric multistate modelling.

BACKGROUND: Patients with idiopathic inflammatory myopathies (IIM) have an increased risk of cancer, but their cancer-related disease burden remains unclear. OBJECTIVES: To explore how cancer might impact the mortality of patients with IIM and examine the associated prognostic factors for cancer and death. METHODS: We identified patients with IIM diagnosed between 1998 and 2020 and ascertained their cancer and death records via linkage to the Swedish healthcare and population registers. Transition hazards from IIM diagnosis to cancer and death were estimated in multistate models using flexible parametric methods. We then predicted the probability of having cancer or death, and the duration of staying alive at a given time from IIM and cancer diagnoses from a crude model. We also explored prognostic factors for progression to cancer and death in a multivariable model. RESULTS: Of 1826 IIM patients, 310 (17%) were diagnosed with cancer before and 306 (17%) after IIM diagnosis. In patients diagnosed with cancer after IIM, the 5-year probability of death from cancer and from other causes was 31% and 18%, respectively, compared to 7% and 15% in patients without cancer after IIM. We reported several factors associated with risk of progression to cancer and death. Specifically, patients with first cancer after IIM who were older at IIM diagnosis, had cancer history, dermatomyositis and a cancer diagnosis within 1 year following IIM faced a greater cancer-specific mortality. CONCLUSION: We observed a substantial increase in mortality from cancer, compared to before, rather than other causes after a cancer diagnosis following IIM, suggesting an unmet medical need for effective cancer management in IIM patients. This finding, along with the identified prognostic factors, provides useful insight into future research directions for improving cancer management in IIM patients.

The Economic Costs of Tobacco Related Illnesses in Kenya.

Objective: To estimate the economic costs of selected tobacco-related illnesses (TRI) in Kenya in 2022. Research Design and Methods: This study was conducted in 2 phases. Phase 1, conducted between 2021 and 2022, entailed conducting a cross-sectional study conducted in 4 national public referral hospitals in Kenya. Patients with cardiovascular disease, cancer, chronic obstructive pulmonary disease, or tuberculosis were interviewed to compute the indirect and direct medical costs related to the illness. Activity-Based Costing approach was used to capture costs for services along the continuum of care pathway. In the second phase, the Tobacco Attributable Factor was used to estimate the direct, indirect, and ultimately economic cost due to tobacco smoking. Results: The estimated health care cost attributed to tobacco use in Kenya is US$396,107,364. Among TRIs included in the study, myocardial infarction had the highest health care cost at US$158,687,627, followed by peripheral arterial disease and stroke with health care cost of US$64,723,181 and US$44,746,700 respectively. The main cost driver across all the illnesses is the cost for medication accounting for over 90% of the total health care cost. The productivity losses from the diseases ranged between US$148 to US$360 and accounted for 27% to 48% of the economic costs. The total cost attributable to tobacco use to Kenya's economy for the selected TRIs was between US$544.74 million and US$756.22 million. Conclusions/interpretation: Tobacco related illnesses impose a significant economic burden as reported for direct and indirect costs. These findings underscore the need for strengthened implementation of the provision of the Framework Convention on Tobacco Control and the Tobacco Control Act (2007) to facilitate a reduction in tobacco consumption in the population.

Direct healthcare costs for people with cerebral palsy in the Brazilian unified health system between 2015 and 2019.

BACKGROUND: Estimate the costs of inpatient and outpatient care for people with Cerebral Palsy (CP) in Brazil. RESEARCH DESIGN AND METHODS: Health records of people with CP in the Hospital and Outpatient Information Systems of Brazil between 2015 and 2019 were analyzed. Variables analyzed were gender, age, ICD, Intensive Care Unit (ICU) use, total cost, and ICU cost. Costs were adjusted for inflation and converted to dollars. Linear regression analysis was performed to investigate the association between social and clinical variables and direct costs. RESULTS: A total direct cost of approximately $166 million to the National Health System was identified, with $7.08 million/year and $26.1 million/year of inpatient and outpatient costs, respectively. The healthcare was primarily for children up to 14 years of age. The ICD 'spastic quadriplegic CP' received the most attendance. Rehabilitation was responsible for 75% of the outpatient care, with physiotherapy standing out. Increased age, use of ICU, and the types of CP are related to increased cost. CONCLUSIONS: Healthcare for people with CP produced expressive costs for the Brazilian public health system, mainly with outpatient procedures and rehabilitation, with children being the most attended. Estimating these costs assist in better resource allocation for more effective healthcare provision.

Economic burden of suicides and suicide attempts in low- and middle-income countries: a systematic review of costing studies.

INTRODUCTION: Suicide is a major public health concern in low- and middle-income countries (LMICs) due to its substantial psychological, social, and economic impact. There is little synthesized evidence to estimate the economic burden of suicide and suicide attempts in such economies. The present systematic literature review aims to examine existing evidence on the cost of illness (COI) in the case of suicides and suicide attempts and assess their quality. METHODS: A systematic review was carried out using electronic databases, such as Medline, EMBASE, EconLit, PsycINFO, and CINAHL using keywords like 'suicide and suicide attempts,' 'cost of illness,' and economic burden." The quality assessment of studies was conducted along with the per-person cost estimation to understand the variation of methods followed across the studies. RESULT: 14 studies qualified for final data extraction and synthesis out of 4,164 studies. The studies showed heterogeneity across objectives, settings, and methods, with cost estimates reflecting a wide range of costings per person in suicide and suicide attempts. CONCLUSION: It is challenging to determine and compare the economic estimates of suicide. Intensive research is warranted with standardized cost assessment techniques and wider perspectives to understand the true economic burden of suicide. REGISTRATION: PROSPERO Registration No- CRD42022294080.

A systematic review of the economic burden of colorectal cancer.

Background: Colorectal cancer is the third most common cancer in the Western Hemisphere. It is the third most common cancer in men after prostate and lung cancers and the second most common cancer in women after breast cancer. According to some studies, the incidence and prevalence of colorectal cancer is increasing rapidly. Main Body: In the present study, a systematic review of the articles related to the economic burden of colorectal cancer was carried out. The articles were taken from the following databases: SID, Medline/Pubmed, Embase, Scopus, Web of Science, NHS Economic Evaluation Database (EED), Econlit, and Google Scholar. Furthermore, the PICOTS model was used to select the inclusion criteria. The quality of the articles' methodologies was evaluated using Drummond's checklist. Then, some data were extracted from relevant articles, in terms of year, place of research, sample size, costing approach, type of measured costs, average direct medical costs, average direct nonmedical costs, and average indirect costs. The data from 37 studies dealing with the costs of patients with colorectal cancer were extracted. Most of the studies were conducted in the United States, and the social perspective was the most common perspective to measure the costs. According to the majority of the studies, direct medical costs were considered the greatest driver in causing the economic burden of colorectal cancer. The costs of hospitalization, medicine, surgery, chemotherapy, and radiotherapy accounted for the largest share of direct medical costs, and the costs of transportation, accommodation, and home care were the greatest share of direct nonmedical costs. Furthermore, the costs associated with disability, absenteeism, and premature death were identified as the main drivers of indirect costs. Conclusion: The findings of this study showed that colorectal cancer imposes great direct and indirect costs on families, the health system, and society. The best way to deal with this disease and, hence, to reduce its economic burden is to take comprehensive preventive measures and modify the lifestyle. In addition, health policymakers can limit the costs of this disease by expanding the screening program.

Healthcare costs attributable to diabetes in pregnancy: A cost of illness study in Tasmania, Australia.

AIMS: To estimate the direct costs during the prenatal, delivery and postpartum periods in mothers with diabetes in pregnancy, compared to those without. METHODS: This study used a population-based dataset from 2004 to 2017, including 57,090 people with diabetes and 114,179 people without diabetes in Tasmania, Australia. Based on diagnostic codes, delivery episodes with gestational diabetes mellitus (GDM) were identified and matched with delivery episodes without diabetes in pregnancy. A group of delivery episodes with pre-existing diabetes was identified for comparison. Hospitalisation, emergency department and pathology costs of these groups were calculated and adjusted to 2020-2021 Australian dollars. RESULTS: There were 2774 delivery episodes with GDM, 2774 delivery episodes without diabetes and 237 delivery episodes with pre-existing diabetes identified. Across the 24-month period, the pre-existing diabetes group required the highest costs, totalling $23,536/person. This was followed by the GDM ($13,210/person), and the no diabetes group ($11,167/person). The incremental costs of GDM over the no diabetes group were $890 (95% CI 635; 1160) in the year preceding delivery; $812 (616; 1031) within the delivery period and $341 (110; 582) in the year following delivery (p < 0.05). Within the year preceding delivery, the incremental costs in the prenatal period were $803 (579; 1058) (p < 0.05). Within the year following delivery, the incremental costs in the postpartum period were $137 (55; 238) (p < 0.05). CONCLUSIONS: Our results emphasised the importance of proper management of diabetes in pregnancy in the prenatal and postpartum periods and highlighted the significance of screening and preventative strategies for diabetes in pregnancy.

Work absence and productivity loss of patients undergoing a trial of spontaneous passage for ureteral stones.

Patients with ureteral stones are often managed with a spontaneous trial of passage. While cost effective, the current literature has not examined the effects of a trial of passage on patients' work productivity. In this study, we aim to characterize work absence and productivity losses in a cohort of patients undergoing a trial of passage for ureteral stones. Actively employed patients aged 18 to 64 and discharged from Duke emergency departments without surgical intervention for ureteral stones ≤ 10 mm were contacted by phone four weeks after their presentation. Participants completed the Institute for Medical Technology Assessment Productivity Cost Questionnaire which assesses three domains: absenteeism - missed work; presenteeism -productivity when returning to work; and unpaid work - assistance with household work. Linear regression associated demographic and stone factors with productivity losses.109 patients completed the survey. In total, 67% of patients missed work, 46% had decreased productivity when returning to work, and 55% required assistance with unpaid work. 59% of patients with stones ≤ 5 mm missed work versus 84% with stones > 5 mm (p = 0.009). African American race (coefficient 23.68, 95% confidence interval 2.24-45.11, p = 0.031), first-time stone formers (coefficient 20.28, 95% confidence interval 2.50-38.07, p = 0.026), and patients with stones > 5 mm (coefficient 25.34, 95% CI 5.25-45.44, p = 0.014) were associated with increased productivity losses. The majority of patients miss work while undergoing a trial of passage and many have decreased productivity when returning to work. This information may help counsel patients in emergency departments, especially first-time stone formers, and prevent return visits.

Burden of non-motor symptoms of Parkinson's disease: cost-of-illness and quality-of-life estimates through a scoping review.

INTRODUCTION: Parkinson's Disease (PD) is a progressive, chronic neurodegenerative disease, representing significant economic and social burdens. It is typically defined by motor symptoms (MSs), however, this does not reflect the full patient burden. Non-motor symptoms (NMSs) are increasingly recognized as central characteristics of PD. However, they still lack recognition in research. Therefore, this study aims to identify relevant NMSs, their prevalence, and the effect they have on Quality-of-Life (QoL) and Cost-of-Illness (COI). Secondly, it aims to identify gaps in the current body of knowledge and propose possible ways future research could bridge those gaps. METHODS: The study employed a scoping review, identifying 60 records for inclusion, using PubMed and Web of Science. It included studies from Spain or Italy, including data on People with Parkinson's Disease. A comparative analysis was performed using Microsoft Excel. RESULTS: It showed that the body of evidence relevant to NMSs, their prevalence, QoL, and COI is limited, or that estimates vary to an extent where interpretation is difficult. CONCLUSION: Most studies suffer from generalization, representation, and standardization issues, stemming from their designs and methodological decisions. Although the findings of this study should be interpreted with caution, several recommendations are made for future research.

Medical Costs of Nontuberculous Mycobacterial Pulmonary Disease, South Korea, 2015-2019.

Nontuberculous mycobacterial pulmonary disease (NTM-PD) prevalence is a rising public health concern. We assessed the long-term healthcare systems perspective of costs incurred by 147 NTM-PD patients at a tertiary hospital in South Korea. Median cumulative total medical cost in managing NTM-PD patients was US $5,044 (interquartile range US $3,586-$9,680) over 49.7 months (interquartile range 33.0-68.2 months) of follow-up. The major cost drivers were diagnostic testing and medication, accounting for 59.6% of total costs. Higher costs were associated with hospitalization for Mycobacterium abscessus infection and pulmonary comorbidities. Of the total medical care costs, 50.2% were patient co-payments resulting from limited national health insurance coverage. As South Korea faces significant problems of poverty during old age and increasing NTM-PD prevalence, the financial and socio-economic burden of NTM-PD may become a major public health concern that should be considered with regard to adequate strategies for NTM-PD patients.